GP Pulse March 2013 Issue 21 - The Royal New Zealand College of ...

GPPULSETHE ROYAL NEW ZEALAND COLLEGE OF GENERAL PRACTITIONERSCrossing boundaries andthinking differently – p2The Quality Symposium 2013, ‘Putting Improvement Science into Practice forChild Health’, encouraged robust and high-quality debate and delegates wenthome enthused with new ideas for how to improve the quality of child health carethrough their practices.The major keynote speakerat the conference will beEmeritus Professor of GeneralPractice at Imperial CollegeLondon, George Freeman.Prof Michael Kidd, President-Elect of WONCA, will bea keynote speaker at thisyear’s Conference for GeneralPractice on generalism.This year’s supreme Maoriof the Year is Kaitaia GPDr Lance O’Sullivan for hiswork serving vulnerablecommunities.Phase 2 of Alzheimer’sNew Zealand’s dementiaawareness campaign haskicked off with TV andmagazine ads.The Royal New ZealandCollege of General PractitionersISSUE 21March 2013

CONTENTSCOLLEGE NEWS10 College of GPs welcomes plainpackaging of tobacco products11 Absolute commitment12 Forever young13 The magic of new life neverfailed to inspireInspired by the magic of new life – p13The Wairarapa loses one of New Zealand’s last GP obstetricians, Dr Simon PriorFEATURESEDITORIAL1 Editorial and Q&A with TimMalloyCOLLEGE NEWS2 Putting Improvement Scienceinto practice for child health –the 2013 Quality SymposiumCOLLEGE NEWS7 Privacy concerns a biggerbarrier to NZ teens accessinghealth care than overseas8 Keynote speakers atConference for GeneralPractice 20139 Introducing new College staffmembers10 New Year Honour for Hutt GP14 Dementia campaign ramps up15 Family history a risk for kidneydiseasePOLICY16 College submissions on behalfof members6 Amalgamated practice is agrowing medical trendRURAL16 Rural Network conference 2013All rights reserved. No part of this publication may be reproduced, stored in an electronic form ortransmitted in any form or by any other means electronically, mechanical photocopying, recordingor otherwise without express permission of the College. Views expressed in GP Pulse are notnecessarily those of the College or the editors.The Royal New Zealand College of General PractitionersPO Box 10440, Wellington 6143Phone: (04) 496 5999, Fax: (04) 496 5997, Email: rnzcgp@rnzcgp.org.nzEditor: Tanya Piejus www.rnzcgp.org.nz/gp-pulse-magazine ISSN: 1178-6795

EditorialThe February highlight for the College was without doubtthe Quality Symposium, held over a stunning summerweekend in Wellington.Our overseas speaker, Professor Martin Marshall from theUK, not only gave an inspiring keynote address, but alsoenthusiastically facilitated other parts of the symposium,including a much-enjoyed Dragon’s Den session on newinitiatives to improve child health in primary care. It was apleasure to host him in New Zealand and hear his pragmaticviews and advice on improvement science.I would like to thank my Board colleague, Dr JohnWellingham, for his excellent oversight of the wholesymposium and his insightful comments betweenpresentations, and the other College members and staffwho contributed to a successful event.Now we look forward to our next event, the annualConference for GeneralPractice. This year we takeas our theme ‘Generalism:The heart of health care’.It’s a theme I’m particularlyenthused about. The futureof generalism is becomingincreasingly complex anddemanding, yet offersexciting opportunities forgrowth and expansion ofthe GP role in an integratedmodel of health care.You can find out more about the Conference for GeneralPractice in this issue of GP Pulse as well as a full write-up ofthe Quality Symposium.Dr Tim Malloy, PresidentQ&A with Tim MalloyDr Tim Malloy, the College President,is a man of many hats.In addition to his College duties, he has had a longassociation with the Rural Chapter (being its inauguralchair), has chaired two PHOs and is a medical educator.He is also a GP at the Wellsford Medical Centre half waybetween Auckland and Whangarei.But what is his vision for the College? What are the realchallenges for 2013? And what, when he gets some sparetime, does he do?Q How many hats have you got on at the moment?A Other than College President, I’m also chair of theWaitemata PHO and President of the General PracticeLeaders Forum. On top of that I am still doing somepractice work as time allows, around 0.6 FTE, andam also on the Redevelopment Group for Grey BaseHospital on the West Coast.Q You’re coming up to ‘100 days in office’ – impressionsso far?A Having been on the Board for some years, I wasfamiliar with the College’s governance, especiallywith the rule changes last year. What I perhaps didn’trealise was the extra time required. Also the thinkingand learning required is a few notches higher asPresident. It gives me a greater appreciation of thejob Harry and his predecessors have done.Q In the last GP Pulse, you noted a few issues you wereparticularly keen to progress. Is there a priority order?A It’s Newton’s law – to every action there is alwaysa complete and opposite reaction. We have finiteresources, so cannot push one project forward atthe expense of another. That said, and while it’searly days, the GP training programme seems to beoperating smoothly. That’s important because it showsthe sector the College’s capabilities extend beyondits core business of looking after members’ interests,providing continuing education and setting standards.The training delivery review is well under way anddue to go to the Board in May. Our members havealso been saying for a while that we need to gear upour advocacy role and I’m keen to put some time intothis.Q Two areas of keen interest to you are rural practiceand practice integration. Aren’t those two mutuallyexclusive?A I work in a rural area in an integrated practice, so itcan be done. But Northland is different from CentralOtago or the East Cape where populations are evenmore scattered. It is definitely not ‘one size fits all’.Doctors are bright, and usually opinionated, people– they will find solutions that fit the vagaries of theirsituation. The more we share, the more we prosper –a plug for this year’s conference right there!Q Just on the conference (Generalism: the heart ofhealth care), do you see a role for generalism in thefuture?A Absolutely, but not as we know it. It is so differentfrom 20 years ago – who knows what it will look likein 20 years. The challenge is leading the debate andputting words into actions – so my advocacy hat is onagain.Q Finally, you’ve got a rare weekend free – what hat doyou wear then?A A farmer’s one.ISSUE 21 : March 2013 : P1

College NewsPutting Improvement Scienceinto practice for child healthThe 2013 Quality SymposiumEach year, the College holds aQuality Symposium to develop ourunderstanding of quality improvementby examining an issue consideredimportant and current to generalpractice and primary care.The theme for the 2013 QualitySymposium was ‘Putting ImprovementScience into Practice for Child Health’.Child health is one of New Zealand’sleading health issues and ImprovementScience is an emerging discipline toimprove health care by addressingthe gap between what the evidencesuggests should happen and whatactually happens in practice.Our topic choice this year arose froman increasing appreciation by healthsector partners of the value of qualityinitiatives for improving child health,both for reversing poor outcomes inchildhood and the longer-term impacton adult health and morbidity.The symposium, held at our nationalmuseum, Te Papa, in Wellington on15 and 16 February, was a stimulatingand thought-provoking event forattendees.Crossing boundariesFriday kicked off with a warmWellington welcome and mihi fromDr Tane Taylor. Symposium MC andquality lead for the College, Dr JohnWellingham, then introduced theprogramme for the two days beforeinviting Associate Health Minister JoGoodhew to make the opening address.Morning tea among the exhibition standsMinister Goodhew stressed that thehealth sector needs to make theconnection between social factorsand health, especially on issues suchas obesity. She then outlined theGovernment’s recent achievementsin health within a constrained fiscalenvironment, which have a solidfoundation in primary care.She also thanked the College forits input on the White Paper forVulnerable Children and stated thatthe health sector has an importantleadership role to play in childprotection. Clinical engagementand leadership are central to theGovernment’s vision for child health,the Minister concluded, and GPs areachieving great results.Dr Wellingham reflected on theMinister’s speech and said we need tofind the barriers to improvement andremove the disincentives, and wiselypointed out that ‘All improvementis change, but not all change isimprovement.’ He then welcomed tothe stage the star attraction of thesymposium, Professor Martin Marshall.Prof Marshall has worked as a GP formore than 20 years and has played aleading role in advancing ImprovementScience at the UK’s Health Foundation.He is one of the world’s leading expertsin the field and we were very excitedto welcome him to Wellington.He started his address by describing thehistory of using medical evidence asP2 : ISSUE 21 : March 2013

College NewsThe Cafe at the End of theUniverseThe session after morning tea was called The Caféat the End of the Universe in which Professor TonyDowell talked about the big issues in child healthand what a quality menu for children might looklike.He discussed what we do well in New Zealand, aswell as what we don’t do so well – high childhoodmorbidity, lack of integration, poor illness-specificoutcomes such as for rheumatic fever, high levelsof violence against children and child poverty,traumatic brain injury in the young, youth alcoholand drug use, and child and youth obesity.Prof Dowell echoed Prof Marshall’s sentiment thatmany problems are complex, but they are all ourresponsibility. He argued that to link child healthand quality we need to take a life-course approach,use existing data, accept complexity and respond toit and think beyond the usual frame.He finished by urging GPs to run more consultationswith children in mind, practice teams to work onchild enrolment, immunisation and identifyingat-risk children, and PHOs and DHBs to conductorganised programmes and share them. And allthree must work on the ‘inedible and unpalatable’.Professor Martin MarshallChange works at thegovernment level withregulations, incentives and soon, but is needed at all threelevels – practice, organisationand government – to belasting, and each on their ownis relatively ineffective.a basis for prescription and diagnosisat the practice level and how it is nowwell entrenched within practice ITsystems.Stating that structural solutions tohealth problems rarely work at anorganisational level, Prof Marshallcited the example of the UK healthservice, which has been constantlyrestructured to little effect. He arguedthat other approaches are needed andthat they’re starting to emerge in theshape of the Triple Aim, PDSA cyclesand others.He then said change also works at thegovernment level with regulations,incentives and so on, but is needed at allthree levels – practice, organisation andgovernment – to be lasting, and each ontheir own is relatively ineffective.Complex environments need complexapproaches to change and noenvironment is more complex thanhealth. There is good organisationalevidence for how to implement changeat all levels, so why don’t we use it?,asked Prof Marshall. He blamed thetime it takes for change to happen,the norms and practices of managerialdecision-makers, the nature of thedecision-making process and the wayevidence is created.Prof Marshall then posed the question:how do we cross boundaries and thinkdifferently to take evidence into thereal world?He cited a fascinating example fromVietnam in the 1980s which wasexperiencing a famine with manymalnourished children and theacademic who found mothers who hadgone against cultural norms to ensuretheir children were well nourished.He encouraged these mothers toshare their practices and achievedan 85 percent decrease in childmalnourishment.Improvement Science likewise crossesboundaries to create positive change.It shares expertise from other sectorsto address complex problems. ProfMarshall gave several more compellingexamples of how this worked in thehealth sector through the Researcherin-Residencemodel, and by usingISSUE 21 : March 2013 : P3

College Newspragmatic response evaluations, largescaleevaluated improvement projectsand in-depth explanatory studies.To be successful, argued Prof Marshall,change projects must be in or close tothe front line, produce generalisableknowledge, build knowledge throughpartnerships, draw on a range ofdisciplines in pragmatic ways and blurthe boundaries of knowledge.Battling dragonsThe afternoon session was aboutframing the issues for children’s health.John Pearce started off by looking atthe costs of doing nothing on childhealth and outlined the connectionsbetween children’s experience ofpoverty, the poorest results and theeconomic cost to New Zealand.Dr Pat Tuohy from the Ministry ofHealth was up next on immunisationtargets and the B4 School Check– what’s been learnt from theprogramme and how it can be used tomake improvements in areas that seemdifficult to change.Echoing the theme from last year’sConference for General Practice,Professor Alan Merry from the HealthQuality and Safety Commission looked‘GPs can changekids’ lives forever’at applying the Triple Aim in NewZealand and how useful it could be inimproving children’s health.Each of these speakers was then invitedto make a pitch, Dragon’s Den style,for a primary care initiative that wouldimprove child health. They had fiveminutes to sell their idea to dragonsDr John Wellingham, Dr David Graysonfrom Ko Awatea and Shelley Frost fromGeneral Practice New Zealand.This proved to be a much-enjoyedsession as it was lighter in tone whilestill conveying some serious messagesand aspirations for improving childhealth. Dr Tuohy’s pitch was that GPsshould become leaders in improvingchild health and protection. His tactics,when questioned by the dragons,included identifying local experts inpractices and PHOs, integrating socialwork into primary care and usingsoftware to predict at-risk children.John Pearce advocated for encouragingparents to talk frequently andpositively to their children from dayone as research shows how importantthis is to the child developing languageand comprehension skills. ‘GPs canchange kids’ lives forever’, he said.Finally, Prof Merry argued for valuesbaseddecision-making to free upresources to go into child health andthe resumption of moral authoritybeing at the heart of patient care. Heurged GPs and nurses to engage andtalk more with their patients and lookafter them. Networking and integratedcare were critical to this, he said, andwe should get rid of the distinctionbetween primary and secondary care.These sentiments were very popularwith the audience.Following afternoon tea was a heartwarmingcase study of teen parenteducational success at He HuarahiTamariki (HHT) where they take theattitude that parenting and educationare equally powerful and can openunexpected doors to young mums.They do this through individualisedlearning programmes and acomprehensive and holistic supportsystem. We heard from three studentswho openly described their challengesand successes at HHT and how it hadchanged their lives for the better.The final session of the day was theWorld Café where delegates had aWhanau OraAnother highlight of day one was Sir MasonDurie outlining the Whanau Ora programme,an integrated approach to Maori wellbeing. Itsprinciples of integrated solutions, distinctivepathways and goals that empower have madea difference to Maori communities through‘brokering opportunities’ rather than providing aservice.Sir Mason DurieThe challenges are much broader than health andinvolve a coming-together of culture, education,literacy, financial nous, employability, te reo, sportand recreation, technology and many other aspectsof wellbeing. Sir Mason’s advice for GPs was toallow patient ownership of records and to diagnoseand build on potential, as well as treating disorders.P4 : ISSUE 21 : March 2013

College Newsexperiences of 358 refugee familiesfrom Burma, Bhutan and Colombia.What became clear through the pilotwas that they didn’t know our healthsystem and how to access primarycare services and used ambulancesand A&E to get treatment, even forminor ailments. Having the rightinformation and resources made allthe difference.chance to share what they learnt fromthe case study and how ImprovementScience can contribute to a commonassessment framework and generalpractice response to child healthimprovements.Thirty delegates then joined Mayorof Porirua Nick Leggett at the Mac’sBrewery for a waterfront dinnerand his thoughts on the community,civic and sector response to theoverwhelming rheumatic fever rate inthe city.Sharing storiesDay two was very practicallyfocused and began with a sessionon implementing a Whanau Oraapproach to improve equity forchildren and their families chaired byTe Akoranga a Maui.Following morning tea we heardanother case study, this time aboutimproving hearing outcomes inchildren. Otolaryngologist Dr MichelNeeff talked about the devastatingconsequences hearing loss can havefor children and what clinicians cando to intervene. Prof Marshall thenjoined in to lead delegates throughan interactive workshop on howprimary and secondary care interfacescan work together to develop aresponse to this important clinicalissue for children.The Dragon’s DenThe third session was on quality toolsto help identify issues for children.Micol Salvetto from WaitemataPHO spoke about measuring qualityusing quantitative data, gap analysisto identify children missing out,decreasing variation as the mostcost-effective way to get measurablehealth gain in the population and howpractices can work together with PHOsupport to make this a reality.Having the rightinformation andresources madeall the difference.Listening to children and theirfamiliesDelegates were particularly impressedby 17-year-old Abbas Nazari, a‘Tampa boy’ whose family fled fromAfghanistan when he was seven. Hespoke eloquently and maturely aboutthe importance of understanding theexperiences of children and familiesand how they contribute to theirhealth and wellbeing.Then Dr Demissie Derissie fromRefugee Services gave an excellentpresentation about the results ofa pilot study to understand theThe next session focused onpractical solutions to improve childhealth. Professor Les Toop gave avaluable presentation on a casestudy of a whole-system approachto quality and clinical governanceand emphasised the need to get theevidence base into health care whilebalancing that with patient choice.He and colleague Anna Aldertondescribed a successful educationand information campaign to stopoverprescribing of omeprazole forbabies.The final part of the symposium wasa case study and issues forum withDr Jane Burrell and Dr Nikki Turnerthat allowed delegates to worktogether on child health issues toshare understanding of what practiceteams can do to improve access,continuity and comprehensive careand reduce risk for children.The Quality Symposium 2013encouraged robust and high-qualitydebate and delegates went homeenthused with new ideas for howto improve the quality of childhealth care through their practices.The College would like to thankall the speakers and facilitators fortheir excellent contributions to aninspiring two days of discussion.Audio files andpresentation slides are at:www.rnzcgp.org.nzISSUE 21 : March 2013 : P5

College NewsAmalgamated practice is agrowing medical trendThe planned amalgamation of Dunedin general medicalpractices Aurora Health Centre and South City MedicalCentre is part of a growing national trend.‘There has been a definite trendtowards practice amalgamations forsome time, but that has acceleratedrecently,’ College president Dr TimMalloy said.‘A number of GPs have determined thatthe business model, care and workforcerequirements mean they need to workin larger practices.’The amalgamated health centre, tobe known as Aurora Health Centreand owned by Aurora South MedicalLtd, will open later this month inMacandrew Road, South Dunedin.It will join the smaller practice of GPsDr Sandy Ross and Dr John Mills, whohave delivered medicine togetherfor the past 30 years, with the largerstructure of Aurora, which has sixdoctors, a registrar, a team of nursesand a practice manager, providing a 3.2full time equivalent (FTE) GP service.The practice will incorporate eightdoctors and a registrar, most of whomwill work part-time as GPs— deliveringabout 5.2 FTEs — while also pursuingother medical areas.The centre will also incorporate alliedhealth professionals, such as counsellorsand osteopaths, and will provide carefor about 6000 patients.Aurora Health Centre founding partnerDr Jill McIlraith said economies of scale,the opportunity to practice medicinein teams, and succession planning allplayed a part in the amalgamation.‘We don’t necessarily want to be a verylarge practice, but to have enoughAurora Health Centre doctors Janice Jensen and Jill McIlraith, South City Medical Centredoctors Sandy Ross and John Mills, and business development consultant Andrew Tucker, ofTucker Consultingpeople and support in a professionalsense so that ultimately our patientshave someone looking after them forthe next 10 or 20 years,’ she said.Dr Mills believed a structure thatallowed female doctors to havefamilies and work part-time, orencouraged older doctors to extendtheir careers, would be important.Southern PHO figures show Dunedinhas a wide range of medical practices,from seven practices with a one or 1.1FTE GP service, catering for fewer than2000 patients, through to two practiceswith more than 10 FTE GPs, cateringfor up to 20,000 patients.Southern PHO Chief Executive IanMacara said there would always bea market for a full range of practicesbut that it was important that issues,such as the aging workforce, successionplanning and ongoing sustainability,were addressed.Many doctors had worked successfullyin the small practice model for manyyears and there was no particularreason for them to change, Dr Malloysaid.‘However, having an expectation thatsomeone would want to “take over”the practice in the future may beunrealistic,’ he said.Patients of larger practices mightneed to adapt to having more of arelationship with a team of practitioners.‘However, it is hoped that the workingcareer longevity of individual doctorsmay increase as the individual burdenon them decreases.’Thanks to the Dunedin Star forpermission to reproduce this article.Credit: Brenda HarwoodP6 : ISSUE 21 : March 2013

College NewsPrivacy concerns a biggerbarrier to NZ teens accessinghealth care than overseasPerceived lack of confidentiality is animportant barrier to young peopleaccessing health care services in NewZealand, says a new study publishedin the March issue of the Journal ofPrimary Health Care.One in six secondary school studentsinterviewed by University of Aucklandresearchers had not seen a doctor ornurse when they needed to in theprevious year. This statistic reflectsinternational studies on youngpeople’s barriers to accessing healthcare. However, an unexpected resultwas that nearly a third of studentsgave privacy concerns as a reason forforgoing health care.‘This was markedly higher than asimilar study utilising data from theUS where 11 percent of boys and14 percent of girls reported privacyconcerns as a reason for forgonehealth care,’ says lead researcherSimon Denny from the Departmentof Community Paediatrics at TheUniversity of Auckland.‘Young people rate barriers aroundconfidentiality and embarrassment ashighly important, in contrast to serviceproviders who consider these barriersof low importance.’The researchers found the mostcommon barrier to students accessinghealth care was ‘not wanting to makea fuss’ with 55 percent citing this as areason not to access health services.However, cost, fear, lack of transport,lack of knowledge of how to accesshealth care and not being able to getan appointment were also importantreasons why some students nevermade it to see a doctor or nurse.Female students, Maori and Pacificstudents, and those living inneighbourhoods with high levels ofdeprivation were the most likely toreport not having sought health carewhen they needed to. In addition,students with chronic health problemsor disabilities, those behaving in waysthat posed a risk to their health orthose experiencing depression weremore likely to report being unable toaccess health care.‘It is of concern that both studentswith health concerns and studentsfrom populations experiencingdisparities in health outcomes weremost at risk of forgone health care, asthese issues are arguably amenable togood quality primary care,’ says SimonDenny.‘Improving health care access foryoung people in New Zealand willrequire a comprehensive approach,with primary care providers beingtrained and responsive to the needs ofthe adolescent population.’Researchers interviewed a randomsample of over 9000 secondary schoolstudents.The Journal of PrimaryHealth Care is at:www.rnzcgp.org.nzISSUE 21 : March 2013 : P7

College NewsKeynote speakers at Conferencefor General Practice 2013Members of the 2013 conference programme committee aredelighted to announce the first international keynote speakersto feature at this year’s conference in Wellington in July.Appointment of an exciting panel ofleading experts is also well under way,which will add enormous value to theprogramme.In a move away from faculty-basedprogramme committees, this year’scommittee includes representativesfrom across the different subjectareas of the College. The committeemembers are:• Mark Peterson, College Boardmember (Committee chair)• Ben Hudson (University of OtagoChristchurch)• Felicity Goodyear-Smith (Universityof Auckland)• Andy O’Grady (Wellington faculty)• Ben Revell (Wellington faculty)• Janine Bycroft (CME)• Bryn Jones (Te Akoranga a Maui)• Sue Domanski (Registrars/education)• Anna Mahoney (College rep)Announcement of the first sponsoris now only a signature away, and anumber of exhibit stands have beensnapped up by organisations in theprimary health sector eager to havea presence among the primary healthcare audience.Professor Michael Kidd isPresident-Elect of WONCA andExecutive Dean of the Facultyof Health Sciences at FlindersUniversity, Adelaide. He also workspart-time as a GP with specialinterests in the care of people withHIV and Indigenous Health.Credit: Australian National UniversityGeorge Freeman is the EmeritusProfessor of General Practice atImperial College London. Withan international reputation inContinuity of Care, ProfessorFreeman worked part-timeas a GP until 2010 and since2011 has focused on medicalgeneralism, now assistingthe RCGP with their newCommission on Generalism.Credit: Imperial College LondonA number of abstracts have beensubmitted, well ahead of the closingdate of 30 April. The committee is keento have interactive workshops as akey feature of this year’s conference.The conference website has detailedinformation on the Call for Abstracts.For more informationon this article:www.generalpractice2013.org.nzP8 : ISSUE 21 : March 2013

College NewsIntroducing new CollegemanagersJeanette Adams,Group ManagerShared ServicesI’m a Wellingtonian. When Ifinished university, I went towork in the UK for what is nowPriceWaterhouseCoopers. I stayedin the UK for 10 years, and thenreturned to New Zealand whereI have worked for a variety oforganisations in finance roles,ranging from a productioncompany, to a bank, a legal firmand, more recently, the Ministryof Health.In my spare time, I look after athree-acre lifestyle block in theWairarapa, play a little golf andtour about the countryside in a1970s MG B Roadster.Linda Scott,HR ManagerI have been working in HumanResources for 15 years. I started atBP South Africa as an HR Advisorand emigrated to NZ in 1999. I haveheld various roles in the publicsector and crown entities, and mostrecently at the Hutt City Council asSenior Human Resources Consultant.My role is to advise on HR-relatedmatters, help coach managers toget the best from their staff, assistthem with recruiting and retainingtalented people, and support seniormanagers to develop capabilitywithin the College.On a personal level, my next goalis to do the 100km Oxfam walkin April, so if any of you havedone it before, please share yourexperience with me.Donna Gordon,CORNERSTONE ®ManagerI have been a Registered Nursefor some 25 years. I workedbriefly in the private sector, thenreturned to a Quality Leader roleat Capital & Coast DHB. One ofmy key roles was to support aservice (Child Health) throughthe accreditation process. I thenmoved to the Ministry of Healthworking in the regulation ofhealth services and most recentlyin the sector auditing healthservices.Outside work, I’m a lead-lighter. Ilook forward to doing it full-timewhen I retire and finally makingthat elusive fortune. If you’d liketo buy some of my work to helpme on my way, let me know!ISSUE 21 : March 2013 : P9

College NewsNew Year Honour for Hutt GPDr Stewart Reid becomes a Member of the New ZealandOrder of MeritHutt GP and College Fellow Dr StewartReid has been made a Member ofthe New Zealand Order of Merit forservices to health. He was recognisedfor his work advising the Ministryof Health for more than 30 years onpolicy, practice and education aroundthe nation’s immunisation schedule.An acknowledged expert on vaccinesas a way of combatting communicableand sometimes life-threateningdiseases, Dr Reid said we’re doing‘reasonably well’, comparedwith other Western countries,in the comprehensiveness of theimmunisations on offer and how manypeople take them up.Dr Reid was involved in theintroduction of the MeNZBmeningococcal vaccination campaignand the consequent safety monitoringsystems. These efforts contributed todeveloping the National ImmunisationRegister. He also provided clinicaladvice for implementing the HPVvaccine programme, targeted atfighting cervical cancer.In 1993, he drafted the firstImmunisation Handbook, a guidewidely used by GPs and hospitalmedical staff to check backgroundinformation on diseases, theirepidemiology, the recommendedvaccines, side effects and what to doif there is a disease outbreak. Dr Reidfinished work on the fifth editionof the handbook in 2011 beforefinally ending his long involvementwith immunisation policy work on anational scale.While carrying out all this work withimmunisation policy, Dr Reid continuedto work at Kopata, then Ropata,medical centres as a GP.Dr Reid and his wife came to NewZealand from Scotland in 1977 witha desire to ‘see around a bit’ beforesettling into a practice. The UnitedStates required them to sit anotherexam, South Africa’s political situationput them off and ‘Australia was fullof Australians’, he said.Before leaving obstetrics about 15years ago, Dr Reid estimates hehelped deliver about 2000 babies inthe Hutt Valley.College of GPs welcomes plainpackaging of tobacco productsThe Royal New Zealand College ofGeneral Practitioners welcomes theGovernment’s decision to bring inlegislation to put tobacco productsinto plain packaging.The College’s President, Dr Tim Malloy,says, ‘Our members are serious abouthelping reduce smoking rates. We aredelighted the Government has decidedto follow the lead set by the AustralianGovernment on plain packaging oftobacco products.‘There are strong grounds for believingthat current packaging glamourisessmoking and that tobacco productspackaged in a standardised colour,typeface and form will improve theeffectiveness of health warnings,reduce misconceptions about relativeharmfulness of various brands andreduce the overall appeal of smoking.‘General practitioners will continueworking with others in the health sectortowards a smokefree New Zealand.’P10 : ISSUE 21 : March 2013

College NewsAbsolute commitmentDr Lance O’Sullivan named Maori of the YearWaitangi Day was a fitting occasionfor Kaitaia GP and College FellowLance O’Sullivan to be named Maori ofthe Year/Nga Toa Whakaihuwaka.Never afraid of controversy, DrO’Sullivan has challenged theGovernment several times aboutthe link between poverty and childhealth, especially campaigning forfunding to fight rheumatic fever in lowsocioeconomic communities.Last year, he resigned from his job atMaori health provider Te Hauora o TeHiku o Te Ika because of his concernsabout how to provide care to patientswho could not pay for their treatment.He has now set up his own practice,Te Kohanga Whakaora (The WellnessNest), which allows him to run healthservices for his high-needs patients theway he believes they should be run.As well as being named supreme Maoriof the Year, Dr O’Sullivan also pickedup the Hauora/Health category in theawards set up last year by currentaffairs programme Marae Investigates.He was a key player in founding theschool-based MOKO programme(Manawa Ora, Korokoro Ora orHealthy Heart, Healthy Throat) atKaitaia Primary School, a health servicewhich operates on the premise thatgood health is a basic right for everychild and every whanau.On presenting Dr O’Sullivan with hisawards, Associate Minister of HealthTariana Turia described his ‘absolutecommitment to the people’.She went on to say, ‘I have been sograteful for Lance’s leadership inhelping us to put in place a preventivecampaign to tackle the unacceptablyhigh levels of rheumatic fever thiscountry has observed over the lastdecade. His dedicated approach toaddressing heart disease and ensuringaccess to treatment is inspiring.‘[His] approaches stem from his beliefthat good health is not simply a matterof ‘treat and wait’ – it is just as vitalthat we create healthy environmentsto achieve wellness.‘Lance is someone who walks thetalk. A father of seven children,and a participant in the Iron Maoricompetition, he understands the needto promote healthy lifestyles as a keycomponent of whanau ora. He hasalways spoken out about the need forall of us to value health, to talk aboutlooking after ourselves.’ISSUE 21 : March 2013 : P11

Features College NewsISSUE 17 : October 2012 : P14Following the success of a trial of thisForever technology over the last two months, youngAuckland Breast Centre is fully adoptingObituary the technology across of its Julian clinics. James-Ashburner, by Dr Buzz BurrellJulian Paul James-Ashburner was bornin Knowledge March 1963 in and England. The sonof communication a vet, he was breathing support medically earlyinfused and accurate air from his detection infancy.I met Julian on our first day at StGeorge’s Primary care Hospital continues Medical to play School, a pivotalLondon role in breast in 1981. cancer He was management. leaning out ofhis In the halls unique of residence’s position window of seeing greetingeverybody patients first with and a more youthful frequently smile and afresh than specialists, cup of tea, GPs’ having awareness, arrived thereearly understanding fully moved and communication in before the is restof critical us mortals for patient had worked care and out wellbeing. whereto go. With a broad Lancashire accent Ireturned Dr Mike Baker, the greeting, Clinical impressed Managing withhis Director organisational of The Radiology skills and Group timeliness, andto radiologist which he at replied Auckland with Breast a cultured Centre,public strongly school supports accent the that need he for had GPs not andunderstood their patients anything to be aware I’d said. of advances Overthe in technology following five so they years can he make workedoninformedmy elocution,decisionsandbasedby graduationon the mostmostup-to-datepeopleinformation.could followThemytopicspeech.ofIn return, I failed in my ability tobreast density diagnosis and associatedreciprocate with his hand-writing.screening issues, though not new,Indeed, even last Christmas we receivedmeans ongoing industry awarenessthe organised, early advent card, andand communication of enhancedsadly could not decipher one word ofclinical outcomes through technologythe hieroglyphs inside.remains a critical factor in the processWith of continuum a perpetually of care. slim physique, hePrimary care continuesto play a pivotal rolein breast cancermanagement. In thesurprised everyone when he stoodalongside the buff muscle-men vyingunique position offor the Mr University title in 1984,playing seeing the character patients ‘Smike’ first fromDickens’ Nicholas Nickleby. He stole theshow, and won more the title, frequentlyand I suspect salesof anabolic steroids radically droppedinthansouth-westspecialists,London for a few years.GPs’ awareness,A prize-winner in academia, he wastippedunderstandingto have illustriousandcareer as asurgeon in London. Instead he invokedhis communication capacity to surprise, this is time thesurgical training schemes competingwith critical each other for for patient his patronage, carechose a general practice trainingand wellbeing.scheme in Northern England. I hadfailed in making his writing legible, butperhaps Baker says, I’d ‘The succeeded radiologists in de-mystifying atthe Auckland quirky Breast dialects Centre spoken and by TRG thenativesare verynorthawareofofthetheWatfordimportancegap.ofAfterbreastadensityvisit toinNewbreastZealandcancer.inBreast1992, density he is emigrated the third highest to join me risk in factorReefton for breast in cancer 1994, where after age his and patients geneticrapidly predisposition. learned to appreciate hisorganisational skills and promptness.At ‘We least were one looking us needed for a scientific these basisattributes, for measuring and breast he had density more than to assistenough us with advising for the two women of us. who neededHe never forgot being Mr University,and his performances on stage werealways legendary, ranging from acountry bumpkin, Charlie Chaplin,Jesus Christ Superstar, to a loinclothedpunkawallah. He enjoyedtrying to make people feel good,either from the stage, the pulpit orthe consulting room. One can onlyassume that he saw his capacityto continue to do this was underthreat when he took his own life onWaitangi Day this year.He additional seemed imaging, to have drunk such as from breast thefountain ultrasound of examination, eternal youth, and annoyingly converselylooking who did nowhere not need near it. The the Volpara 50 yearsof product age his FDA next approved birthday would and provides havebeen. us with In an our accurate, memories reproducible he always andwill rapid be measurement the loyal, reliable of breast friend density.’ andyouthful entertainer.He had the talent to surprise, wasFor more informationalways organised and early foreverything. about this None article of us predicted go to: hewould be all three for his departurefrom www.theradiologygroup.co.nzus too.Rest www.aucklandbreastcentre.co.nzIn Peace Julian. You will behugely missed by so many.The Royal New ZealandCollege of General PractitionersReceive the latest updates, information, and College news—join us on Twitter, Facebook and LinkedInYou’ll find the links at the bottom of the College website and in ePulse.P12 : ISSUE 21 : March 2013

College NewsThe magic of new life neverfailed to inspireObituary for Dr Simon PriorBorn in Masterton, 7 October 1954;died 12 January 2013, aged 58‘The day the magic of new life endsis the day I will retire,’ said Dr SimonPrior to his Masterton colleagues.His wish was to be the last GPobstetrician in the country. At thetime of his death in January, he wasclose to achieving that wish, beingone of only around 30 New ZealandGPs still involved in delivering babies.Dr Prior came from a well-establishedWairarapa medical family, withhis father Owen and grandfatherNorman both doctors based inMasterton. Two of his three childrenhave continued the tradition byqualifying as doctors and haveworked during their medicaltraining in the Wairarapa. DaughterSarah spent a month as a locumat Masterton Medical workingalongside her father.He was educated at RathkealeCollege on the outskirts ofMasterton, excelling as an academic,sportsman and musician, then studiedmedicine at Otago. He returnedto his hometown during vacationsto work at Masterton Hospital andbecame a house surgeon there afterqualifying. He finally set up a GPpractice in town and continued toserve the Masterton community untilhis untimely death in January froman aggressive cancer.Alongside his unswerving dedicationto his patients, his friends and familyhave described Dr Prior’s sense ofhumour, sharp mind, generous spirit,and love of sport – especially cricket– and music. He was also a counsellor,mentor and teacher to many friendsand colleagues, and had a passion forpet birds, dogs and cooking.Dr Prior’s funeral was held at his almamater, Rathkeale College, wherearound 800 mourners farewelled amuch-loved and respected GP, familymember and friend.(Above) Dr Simon Prior (middle,standing) with daughter Sarah andfather Owen. Seated is Phyllis Wiltonwho has been treated by the fourgenerations of Drs Prior, includingSimon’s grandfather Norman.Credit: Wairarapa NewsISSUE 21 : March 2013 : P13

FeaturesDementia campaign ramps upLook out for Alzheimers New Zealand advertising this monthIn the September 2012 GP Pulse, Alzheimers New Zealand told us about their new campaign to raise awareness ofdementia, which started with the launch of the informative ‘We Can Help’ website and a TV commercial.The sector-wide campaignwas developed to deliver onStrategic Goal 2 from theNational Dementia Strategy2010–2015: to build publicawareness about dementiaand the services and supportavailable to people affectedby dementia, and to helpde-stigmatise dementia.Phase 2 of the campaignincludes a mix of televisioncommercials, magazineadvertising and editorialcontent with facts aboutdementia and the personalexperience of dementia.TV advertising will initiallyrun on Prime TV, andadvertising will run in theAustralian Women’s Weekly,Next magazine and Northand South.‘The campaign, managedby Alzheimers New Zealand, aimsto reduce the stigma sometimesassociated with dementia and toencourage people to see a doctor ifthey or someone they know is showingsigns of the condition,’ said HealthMinister Tony Ryall.‘Finding out you have dementia isdifficult; however, the sooner youknow the sooner you and your familycan benefit from the help available.It also ensures you have access toappropriate medicines to try and slowdown the advance of the condition.‘The one-off funding has also beenused to help clinicians make earlierdiagnoses and support people affectedby dementia, such as the developmentof online training tools and a clinicalsupport forum.‘As the number of New Zealandersliving longer increases, the number ofpeople with dementia will also grow.Caring for more people with dementiawill be one of the major challenges inthe future.’A timely diagnosis will often mean aperson can keep living independentlyfor much longer. People typicallyIntroducing the NationalDementia CooperativeThe National DementiaCooperative (NDC) was establishedto ‘cooperate and collaboratewith like-minded people whoare passionate about advancingknowledge of approaches todementia care in New Zealand’.Anyone with an interest indementia can participate. Peoplealready involved come from awide range of occupations andbackgrounds. Members work inpartnership, sharing resources,information, skills, trials anderrors. Membership is free andinformal – just email marja.steur@waitematadhb.govt.nz orvisit ndc.hiirc.org.nz.live with the diagnosis of dementiafor many years, and a significantportion of this time can be at home.With a timely diagnosis, people withdementia, their family and carers canstart taking practical steps, such asarranging their legal and financialmatters, and getting the care andsupport they need.For more informationabout this article:www.wecanhelp.org.nzP14 : ISSUE 21 : March 2013

FeaturesFamily history a risk for kidneydiseaseMarking World Kidney Day with Kidney Health New Zealand‘Is there a history of kidney disease inyour family?’ is the question KidneyHealth New Zealand will be asking onWorld Kidney Day 2013 on Thursday14 March, during Kidney Health Week.Its aim is to highlight that people witha family history of chronic kidneydisease (CKD) are at increased risk ofdeveloping kidney disease themselves.Inherited diseases with a knowngenetic abnormality, such as polycystickidney disease, are well recognisedand families are usually aware of theirfamily history and their risk of havingkidney disease. It is not so well knownthat people with kidney failure causedby diabetes, high blood pressure orglomerulonephritis are likely to haveother family members with CKD. Aperson with a family history of CKDis three to nine times more likely todevelop kidney failure than a personwithout such a family history. Thisappears to be particularly true forMaori and Pacific families.Around 600 New Zealanders startdialysis for treatment of kidney failureeach year. Kidney failure has profoundeffects on the lives of patients andtheir families and its treatment isexpensive, costing the health systemover $100 million annually. CKD issilent, with 80-90 percent of peopleunaware they have it. Early detectionis simple and offers the chance ofpreventing or slowing the progress ofCKD.During Kidney Health Week, KidneyHealth New Zealand, kidney unitsand patient support groups will beencouraging family members of peoplewith kidney disease to consider askingtheir doctor to check out their kidneys.They will be giving family membersthis card to take with them when theyvisit their GP. Look out for it duringconsultations this month.For more informationon this article:www.kidneys.co.nzISSUE 21 : March 2013 : P15

PolicyCollege submissions on behalfof membersA reminder about where to find themThe College makes a large number ofsubmissions on behalf of its members.The submissions cover a wide range oftopics and are largely in response tothe Ministry of Health, PHARMAC, orother health agency consultations orrequests for feedback.In 2012, we made 29 submissions ontopics as diverse as mental health andaddiction, vulnerable children andchild poverty, community pharmacyand self-care.Our first submission of 2013 was tothe Pharmacovigilance Ethics AdvisoryGroup at the University of Otagoon a document entitled ‘MedicineSafety for New Zealanders: EthicalIssues regarding the use of routinelycollected data from General Practicefor Pharmacovigilance’.You can find submissions we havemade on our website at www.rnzcgp.org.nz/submissions and we will reporton ones of particular interest orsignificance here in GP Pulse. See theFebruary 2013 issue for a summaryof our submission on Diagnosis andManagement of Prostate Cancer inNew Zealand Men.Rural Network conference 2013This week it’s the New Zealand Rural General Practice Network’s2013 conference – the country’s showcase rural health event.The 2013 conference, scheduled forMarch 13-17 at the Rotorua EnergyEvents Centre, carries the theme‘Let’s Get Connected’. The conferencewill feature topics such as the RuralBroadband Initiative and technology inhealth, and will also forge links withrural health and other groups suchas the New Zealand Rural HospitalNetwork (NZRHN) and the newlyformedRural Health Alliance AotearoaNew Zealand (RHANZ).There’s also a host of pre-conferenceworkshops, concurrent sessions andkeynote speakers – in fact, somethingfor every member of the practice team:doctors, nurses, practice managers andadministrators.Keynote speakers include ProfessorLesley Barclay (head of SydneyUniversity Centre for Rural Health,School of Public Health), Te UruroaFlavell (Maori Party MP, Waiarikielectorate), Chai Chuah (nationaldirector of the National Health Board)and Graeme Osbourne (director,Information Group in the Ministryof Health’s National Health Boardbusiness unit), and Henare O’Keefe(Hastings District Council councillor andcommunity advocate) and more.The popular Nurses’ Forum returns.Also returning to the programme is thePat Farry Rural Health Education TrustFun Run and Walk. The course for theevent – now in its second year – is theRotorua lakefront, offering participantsthe opportunity to take in the sights,sounds and smells of this uniquesetting. Southern Cross Primary Carehas again kindly sponsored the fun runand walk. Be in on the early morningaction, get a fresh start to the day’sprogramme, and get the t-shirt and achance to win a prize!Half-day with RHANZ a highlightThe conference includes a half-dayon 13 March dedicated to the newlyformed Rural Health Alliance AotearoaNew Zealand (RHANZ). Modelledon the Australian Rural HealthAlliance, RHANZ brings togethermedical, nursing, pharmacy andallied health groups, with social andpolitical organisations involved inrural communities to develop policyadvice and advocate on behalf ofcommunities with a strong unifiedcross-sector voice.The RHANZ programme will featurekeynote speakers, AGM anddinner. Speakers include ProfessorLesley Barclay (head of SydneyUniversity Centre for Rural Health,School of Public Health), Robin Steed(NZ Institute of Rural Health), LindaClarke (Dairy Women’s Network) andJeanette Maxwell (Federated Farmers).For more informationabout the conference:www.conference.co.nz/nzrgpn13P16 : ISSUE 21 : March 2013